With cooperative child – almost entire exam can be accomplished with a tongue blade
Ask child to open mouth, move tongue in different directions for full visualization.
Depress tongue for full visualization of back of mouth, ask pt to say “ahh” (tonsils, uvula, oropharynx)
You may ask child to use their fingers to move the outer lip and cheek to visualize buccal mucosa or lining of the cheeks.
In Infants:
Keep mouth exam until last or do it during episodes of crying.
Use of a tongue depressor (usually flavored) is necessary.
Assess child’s lips – should be moist, soft, smooth, and pink. Assess symmetry when child laughs or cries.
Inspect mucous membranes for color, any areas of white patches or ulceration, bleeding, sensitivity. (Should be moist, smooth, glistening, bright pink.)
Inspect teeth and bite pattern.
Chalky white to yellow-brown areas on the enamel may indicate fluorosis (excessive fluoride ingestion)
Whitish coating on teeth may indicate need for dental hygiene teaching
Examine gums – color is normally coral pink
Inspect tongue for papillae (small projections that contain taste buds).
Tongue should extend past lips when child sticks it out.
Roof of mouth – hard palate – should be intact, bumpy and dome-shaped.
Examine oropharynx and palantine tonsils. – normally the same color as the surrounding mucous and glandular rather than smooth, and barely visible.
The size of the tonsils vary considerably during childhood.
Report any swelling, redness, or white areas on tonsils.
In Infants: